Lymphomatous infilration of the peripheral nervous system in enteropathy-associated T-cell lymphoma

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Yoon-Sim Yap, Adrian Cummins, Peter Blumbergs, Jennifer Hardingham, Sunil Dabadghao and John Norma

Should I endorse a third party? Authorization strategies for brand manufacturers in a refurbishing market

Original equipment manufacturers (OEM) may have little or no control over third-party (3P) refurbishing firms. With the rapid growth of the refurbished market for electronic products, we study whether it is beneficial for an OEM to cooperate with a 3P via authorization schemes that boost an OEM’s brand reputations, increase their sales, and strengthen consumer acceptance of authorized 3P’s refurbished products. We examine the conditions under which both the OEM and the 3P benefit from the authorization strategy, studying the trade-off between the indirect benefit of authorizing a 3P to increase market share and the downside of cannibalizing new-product sales. To estimate our model’s behavioral parameters, we conduct an extensive experiment on MTurk to capture consumer preferences and cannibalization effects. The experimental study examines the price-perceived quality relationship along with brand value, seller identity (OEM, 3P), and product condition; its results show that the discount and seller identity play a large role in consumer choice and that cannibalization is generally linear in price. We subsequently construct a revenue maximizing model that incorporates this linear cannibalization effect, along with the authorization fees. We show that refurbished products offered by authorized 3Ps have higher demand than those that are not authorized and that it is beneficial for 3Ps to participate in these schemes despite the authorization fees. We conclude that authorization can be a win–win strategy for OEMs and 3Ps, especially when low-end consumer demand and average reduction of refurbishing costs are relatively high, and the level of cannibalization is relatively low. To achieve win–win solutions, it is important for OEMs and 3Ps to consider brand recognition, consumer behavior related to refurbished products, and remanufacturable supply.</p

Global sourcing under tariffs:A perspective of time series analysis

Global sourcing is a complex process to acquire products and services from international sources, and therefore is subject to various disruptions. This paper focuses on the effects of the large-scale tariffs during 2018–2019 on global sourcing behaviors. Drawing on tariff implications from analytic models of global supply network design, we specifically examine the patterns of global sourcing and how tariffs could disrupt global supply chains by investigating time series of monthly sourced amounts. We draw 222 manufacturing firms from the FactSet Shipping database, with 3,348,595 unique observations covering time period between January 2014 and December 2019. By applying multivariate time series clustering algorithm, we identify seven unique clusters for these firms. We further examine the disruptive effects of these tariffs by using intervention analysis of time series in each cluster. The results of intervention analysis demonstrates that disruptive effects differ in each cluster. An additional analysis reveals that firm size, growth potential, and firm profitability are associated with firms’ ability to deal with disruptions. Overall, our results have important implications for global supply chain management.</p

Supplier sustainability: A comprehensive review and future research directions

Sustainability is not a one-player task. Organizations have started to realize that their supply chains have a significant social and environmental impact, usually greater than their own operations, and managing sustainability at suppliers is crucial for supply chain-wide sustainability. Supplier sustainability management (SSM) research is fast evolving across multiple disciplines but lacks an interdisciplinary review to guage the progress made, and to decide the path forward. Heightened global focus on sustainability compels us to explore research avenues in SSM for meaningful progress. In this paper, we provide a comprehensive review of SSM research including the most recent work. We propose the Motivation-Measure-Analyze-Improve-Govern (MMAIG) framework for supplier sustainability, identify the limitations of current SSM research in enabling this framework, and propose future research directions. Our key observations are that (a) current SSM research is heavily focused on measuring and monitoring supplier sustainability, and (b) supplier sustainability improvement/development research is limited and the majority of it is about sustainable supplier selection. The future research directions that we propose are centered around (a) optimizing the investments towards supplier sustainability through collaboration, proposing mechanisms that consider risks, liabilities, and gains of all parties, and (b) considering behavioral aspects to overcome SSM implementation issues. Organizations can achieve efficient improvement in supplier sustainability by using a collaborative approach that is data-driven and trust-based. We discuss several mechanisms within our MMAIG framework that can help organizations in their collaborative approach

Nocardiosis in patients of chronic idiopathic thrombocytopenic purpura on steroids

We present two cases of chronic idiopathic thrombocytopenic purpura (ITP) on prolonged steroid therapy who developed subcutaneous and brain abscesses due to Nocardia asteroides. The special diagnostic and therapeutic challenges encountered in the patients because of severe thrombocytopenia are being highlighted

A clinical study of cardiac rhythm disturbance in patients with chronic obstructive pulmonary disease using 24 hour Holter monitoring

Background: Chronic obstructive pulmonary disease (COPD) has been defined by GOLD (guidelines for obstructive lung disease) as a disease state characterised by airflow limitation that is not fully reversible, with FEV1/FVC <70%. COPD increases the risk of cardiac arrhythmias. In acute exacerbation and also in stable COPD, it has been found that arrhythmias are associated with more mortality. Holter monitoring enhances the possibility of observing cardiac rhythm during symptoms and can detect arrhythmias in asymptomatic patients. The aim of this study was to estimate the prevalence and types of arrhythmias in COPD patients and to correlate them with severity.Methods: This was a cross-sectional prevalence, analytical study conducted for a period of two years. Fifty cases with sign and symptoms of COPD diagnosed on pulmonary function tests (PFT) as per GOLD’s criteria were included. Diagnosis of arrhythmia in COPD was on the basis of Holter monitoring. 24 hour Holter monitoring was done with Release 2.9 Digitrak XT Philips. The data was analysed using chi square test.Results: The most common arrhythmias on Holter monitoring were atrial pair and atrial premature beats which were present in 29 (58%) and 25 (50%) patients respectively, atrial run (32%), ventricular premature beats (32%), ventricular couplets (30%), ventricular triplets (24%), ventricular trigeminy (24%) and ventricular run (22%). Atrial fibrillation was noted in 7 patients (14%).Conclusions: The significant presence of supraventricular and ventricular arrhythmias in patients with COPD were detected on Holter monitoring.

Primary Sjogren's syndrome : rarity in India

Objective : Primary Sjogren's syndrome (SS) is rarely reported from India. We have studied the clinical spectrum and immunological profile of patients with primary SS. Methods : A prospective analysis of patients with primary Sjogren's syndrome fulfilling San Francisco criteria, seen at our clinic in the last 10 years was carried out. Results : The study included 26 patients, 21 being women. The presenting symptoms included dry eyes, dry mouth, and arthritis/ arthralgia. Extra-glandular manifestations were glomerulonephritis, vasculitis, renal tubular acidosis and peripheral neuropathy. The important laboratory abnormalities were hypergammaglobulinaemia (16/20), antinuclear antibodies (18/26), anti-La (11/19) and anti-Ro (10/19). Minor salivary gland provided a definitive diagnosis in 16/26 (60%). Conclusion : The prevalence of primary Sjogren's syndrome is rare even in tertiary care rheumatology clinics. The clinical and immunological profile as seen here is similar to that reported in Western countries

Challenging Perioperative Management of a MEN2A Syndrome Patient Complicated by Eisenmenger Syndrome

Multiple endocrine neoplasia type 2A (MEN2A), is associated with pheochromocytoma and medullary carcinoma of the thyroid. A surgical procedure in these patients can be complicated if they have any congenital heart disease (CHD). Nowadays, CHD patients are increasingly presenting at advanced age for non-cardiac surgeries, posing unique challenges to anesthesiologists. We hereby present a 44-year-old male with Eisenmenger syndrome (ES) and MEN2A, scheduled for bilateral adrenal excision and thyroidectomy. Patients with ES require meticulous and goal-directed management during non-cardiac surgery, depending upon pulmonary hypertension, cyanosis, and right ventricular dysfunction

Glucose tolerance abnormalities in Australian women with polycystic ovary syndrome

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Objectives: To determine the prevalence of glucose tolerance abnormalities and to identify associated risk factors in women with polycystic ovary syndrome (PCOS) attending a reproductive endocrinology clinic. Design: Retrospective chart review. Participants and setting: 372 women with confirmed PCOS attending a reproductive endocrinology clinic at Adelaide University’s Research Centre for Reproductive Health. Main outcome measures: Prevalence of glucose tolerance abnormalities and association of such abnormalities with potential risk factors. Results: 4.0% (15 women) had diabetes mellitus, 15.6% (58) had impaired glucose tolerance and 80.4% (299) had normal glucose tolerance. There was a significant trend towards increasing prevalence of diabetes with increasing age (odds ratio [OR], 0.60; P= 0.0085). The prevalence of abnormal glucose tolerance (diabetes and impaired glucose tolerance together) was significantly higher with higher waist circumference (OR, 2.9; P = 0.05), higher body mass index (OR, 8.02; P= 0.0253), a family history of diabetes (OR, 1.56; P =0.0192) and the presence of metabolic syndrome (OR, 5.62; P<0.001). Conclusion: The prevalence of diabetes and impaired glucose tolerance is high in women with PCOS, especially in older women and those with abdominal obesity and a MJA 2007; 187: 328–331 family history of diabetes.Preeti Dabadghao, Bronwen J Roberts, Jim Wang, Michael J Davies and Robert J Norma

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

BACKGROUND: Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS. METHODS: International healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations. RESULTS: This paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years post-menarche; > 90 days for any one cycle (> 1 year post-menarche), cycles 45 days (> 1 to  35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Müllerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an 'at risk' label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8 years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Available data endorse the benefits of healthy lifestyle interventions to prevent excess weight gain and should be recommended. For symptom management, the combined oral contraceptive pill and/or metformin may be beneficial. CONCLUSIONS: Extensive international engagement accompanied by rigorous processes honed both diagnostic criteria and treatment recommendations for PCOS during adolescence.Alexia S. Peña, Selma F. Witchel, Kathleen M. Hoeger, Sharon E. Oberfield, Maria G. Vogiatzi, Marie Misso, Rhonda Garad, Preeti Dabadghao and Helena Teed